In Rare Cases of Indigestion, Baking Soda May Be a Peril

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Baking soda, like aspirin, bandages and rubbing alcohol, has been a staple in medicine cabinets for more than a century. Over that time, billions of doses of sodium bicarbonate have followed holiday feasts, spicy foods or samplings of unusual recipes into the digestive systems of the nation.

Few people report adverse effects from the common household chemical. But ingesting it has been associated with scattered cases of stomachs bursting, presumably because of carbon dioxide gas the compound releases into the digestive organ when it is unusually full.

"I nearly died after taking this stuff," said William Graves, who suffered a rupture through the wall of his stomach in 1979 after taking baking soda mixed in water for indigestion after a big meal. The 64-year-old resident of Bethesda, Md., who is editor of National Geographic Magazine, said that only emergency surgery saved his life and that six more operations were needed to repair the damage. Rupture of Stomach

He said the incident occurred while he was on vacation after an evening when he consumed two vodka martinis, a bowl of chili with corn chips on the side, a salad, corn bread, a glass of red wine, cookies and an after-dinner brandy. Soon after going to bed, he awakened with indigestion and mixed a teaspoon of baking soda with a small amount of water. Less than a minute after drinking it, he said, he collapsed in agony when a two-and-a-half-inch rupture occurred in the inner curve of his stomach.

He sued Church & Dwight Inc., of Princeton, N.J., whose Arm & Hammer Division is the nation's main supplier of the compound. The suit contended that the product did not carry adequate warnings and asked that baking soda be removed from the market as an antacid.

A Superior Court jury in New Brunswick, N.J., decided on Oct. 4 that labeling on baking soda at the time of the incident was inadequate, but did not conclude that the chemical had caused Mr. Graves's stomach problems and declined to award any damages.

Both sides claimed victory after the trial. "We won on the point that the label should have warned about the danger of stomach rupture," Mr. Graves said. Dwight Minton, chairman of Church & Dwight, said, "This has been in common use for hundreds of years, and literally hundreds of millions of people have used baking soda products in billions of cases of indigestion with few reported ill effects."

The Food and Drug Administration has been reviewing the uses of sodium bicarbonate as part of its program to examine older nonprescription drugs listed as "generally regarded as safe." Of 64 uses being looked at, the compound has so far been approved as safe and effective in 7, including use as an antacid, said Sharon Snider, a spokeswoman.

Chemically, sodium bicarbonate is a base that consumes and neutralizes acid. Byproducts of this reaction include water and carbon dioxide gas, which bubbles off and forces burping.

But many experts do not consider sodium bicarbonate the treatment of choice for indigestion, even though it is effective and cheaper than most other antacids, said Dr. Stanley B. Benjamin, chief of the gastroenterology at Georgetown University Medical Center in Washington. "Physicians don't tell people to take baking soda for indigestion, even if it works, because of all the sodium it contains," he said. "Excess sodium causes things like high blood pressure, heart disease and kidney problems."

Dr. Benjamin said stomach ruptures were rare in cases that did not involve an ulcer or other abnormality. "The normal stomach is a tough, multi-partitioned organ that hardly ever ruptures," he said. "But like any other sac, like a balloon, it has a bursting point."

Mr. Graves and his lawyers said their search of world medical literature had uncovered about 18 cases of stomach rupture associated with baking soda since the 1920's, including those of at least 6 people who died. But Clifford James, a lawyer representing the company, said the defendants had found only six to eight "unambiguous" associations between stomach rupture and use of sodium bicarbonate. The only death connected with taking baking soda in water occurred in a 1939 case, he said.

"When these rare instances occur, the patient has had some underlying problem with his stomach," he said.

The company said it had never promoted or marketed baking soda as a treatment for indigestion but, because people use sodium bicarbonate for this purpose, had long included instructions on dosage and some warnings, like a warning not to administer the product to small children.

Mr. Minton said an independent study commissioned by the company had concluded that baking soda produced too little carbon dioxide in a short period to be a likely cause, except possibly in rare cases when a stomach was overloaded and not emptying properly, so that the addition of anything else could lead to a rupture.

As a result of the study, the company in late 1983 added a warning to its baking soda boxes that is still in use: "Do not ingest food, liquid or any antacid when stomach is overly full to avoid possible injury to the stomach."

A version of this article appears in print on November 27, 1991, on Page C00008 of the National edition with the headline: In Rare Cases of Indigestion, Baking Soda May Be a Peril. Order Reprints|Today's Paper|Subscribe